Healthcare Provider Details

I. General information

NPI: 1265915029
Provider Name (Legal Business Name): NKGEN BIOTECH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 DAIMLER ST
SANTA ANA CA
92705-5812
US

IV. Provider business mailing address

3001 DAIMLER ST
SANTA ANA CA
92705-5812
US

V. Phone/Fax

Practice location:
  • Phone: 949-396-6830
  • Fax: 949-396-6831
Mailing address:
  • Phone: 949-396-6830
  • Fax: 949-396-6831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCDF00341215
License Number StateCA

VIII. Authorized Official

Name: MR. STEPHEN CHEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 949-396-6830